Tall kan ha en egen overbevisningskraft. En setning om befolkningsveksten i Karachi – 11 år frem i tid, er slik. Man blir helt stille, mye annet blir uvesentlig når man leser:

Karachis nåværende befolkning er på 16 millioner. I 2020 er den forventet å doble seg – til 32.5 millioner.

Når man tenker på Pakistans nåværende problemer, må man lure: hvordan skal staten hanskes med problemene? Allerede i dag er Pakistan på randen av å være en «failed state».

Heldigvis har Pakistan samfunnsforskere som ser problemene. Man må spørre: Kina gjennomførte en brutal ett-barnspolitikk. Hvordan skal land som Pakistan kunne løse fremtidens problemer uten tilsvarende radikale grep?

Out of control

Karachi’s current population stands at 16 million and by 2020 it is expected to double to 32.5 million. The city’s resources, however, remain limited

By Aroosa Masroor

Arbab Bibi, a Sindhi housemaid and resident of Chanesar Goth, recently lost her child at the time of her birth. But she did not mourn her loss for more than a week and was back to work.

A mother of five, she hopes to bear more children once her condition is «stable», she says. Little does she know that every child she has not only affects her health but that of the city too. Each child adds to Karachi’s existing population, and in turn increases the burden on the city’s extremely limited resources.

But Arbab is not the only one who remains ignorant, as having a large family (with an average of five to six children) is the norm in Pakistan’s urban areas. Although inflation has made it difficult for the father – normally the sole breadwinner in a family – to feed all family members, the rate of population growth remains high (1.9 per cent) compared to other countries in the region.

Population growth rate highest in the region

Compared with the census in 1981, when the growth rate stood at three per cent, it has declined but economists warn it is still higher than most countries in the region including India, Bangladesh and Iran.

According to statistics given on the Government of Pakistan’s website, the country’s current population stands at 165 million – and counting. The province of Sindh constitutes about 42 million people, (or 25 per cent). Out of this total, only 22.75 per cent of the population is economically active and the rest is seen by economists as a burden.

‘Demographic bomb dangerous than atomic bomb’

But figures alone do not define the gravity of the situation, say experts. «This demographic bomb is even more dangerous than the atomic bomb. Our government will never succeed in providing ‘health and education to all’ if our fertility rate is not reduced,» remarks social worker and activist Nargis Rahman, also the president of Pakistan Women’s Foundation for Peace.

Dr Akhtar Hasan Khan, a former secretary for planning, in his recent article published in an English daily points out that it is the Total Fertility Rate (TFR) – the number of children born to a woman in her reproductive span – that better indicates where we stand today. Pakistan’s TFR stands at 4, compared to 3.2 in Bangladesh, 3.1 in India and 2.1 in Iran, despite its conservative leadership.

In the case of Karachi, however, it is not just TFR that matters. The numbers in this city have mostly risen with increasing migration from rural parts of the province. Employment and better standard of living attracts them to the capital of Sindh where they continue with their traditional practice of having large families, despite their poor economic conditions. The use of contraceptives among this segment is also absent.

While some quarters argue that it is immoral to raise the question of contraceptives as each individual bears his own economic responsibility, it is necessary to evaluate and understand the effects of a growing population. «For parents it may just be an extra mouth to feed, but for the government that extra child puts stress on the limited resources. The child would want safe drinking water, access to healthcare and education and will also generate more solid and liquid waste. The burden then ultimately lies on the state, not the family,» says Rahman.

Economists, however, suggest that this phenomenon of rising population is gender-related as women do not have the right to decide the size of their family. In the early nineties, the government made an effort to motivate the population to use contraceptive pills but failed. As a result, help of the non-government sector was sought. Marie Stopes Society (MSS), a global partner of MSS-UK, was one such committed partner that stepped into the country in 1991 to provide the urban and rural populations with efficient family planning and reproductive health services. They have about 100 centres in the four provinces of Pakistan, eight of which are in Karachi, and a toll-free helpline number across the country for advice on sexual and reproductive health.

«In the past we have seen that the government’s strategy of ‘kam bachay khushal gharana’ did not bear positive results. We changed our strategy and focused on encouraging couples to have children by choice, not by chance,» says Dr Naveed Ahmed of MSS while talking to Kolachi.

Dr Ahmed explains that MSS builds its programmes towards changing behaviours through counseling rather than urging couples to have smaller families, which they are initially reluctant to do. «It takes couples a while to understand the importance and benefits of a small family.» He also says that in most cases, the challenge is to convince the husbands who not only discourage the use of contraceptives, but refuse to accompany their wives to clinics for advice.

Abortion better than precaution

Dr Neelofar Sami, working in the Reproductive and Health Services sector at the Aga Khan University Hospital (AKUH), concurs. «Husbands prefer terminating pregnancies than taking contraceptives,» she reveals. According to a pilot study conducted by doctors at AKUH including Dr Sami, an average family in Karachi has four children. «The contraceptive prevalence among the educated class is relatively high (56 – 60 per cent) and among the less educated, the rate of abortion is high.»

Most couples, she adds, fear the side effects of modern contraceptives. «They feel an abortion is an easier way to get rid of the child than disturbing the reproductive cycle of a woman.» Surprisingly, most women agree with their husbands about this, she adds. She also pointed out that rising inflation over the past year has significantly changed the attitude of some couples who intently listen and follow their doctor’s advice at family planning centres.

But Dr Ahmed is of the opinion that efforts of doctors and family planning centres will not help decrease the TFR unless services are provided by the government at mass level, especially in rural parts of Sindh. «We have our out-reach workers and counsellors in the rural areas, but due to limited resources, it is impossible for us to reach out to each and every village in the 23 districts of Sindh,» he says, adding that illiteracy is another factor limiting the success of family planning programmes as most families refuse to give up their traditions of having more children.

Rahman observes that this trend is more prevalent among certain ethnic communities. «Sindhis and Baloch who have lived in Karachi for generations have large families, even though family planning centres exist in most areas,» she says.

Bilquis Edhi, wife of philanthropist Abdus Sattar Edhi, adds that in her experience, it is the migrant Afghan and Pukhtoon families that have bigger families. «We organise mass marriages frequently among different ethnic communities, and all the Afghan families I have met have multiple wives and close to thirteen children on average. Even after migrating to urban areas, they continue their traditional practices from rural areas where more children promise more money by working in the field.» In Karachi, however, most children end up begging on the streets.

Population higher in Katchi Abadis

In a study ‘The case of Karachi’ conducted by renowned architect and urban planner Arif Hasan, it is pointed out how the rapid urbanisation of Karachi and migration from different parts of the country has given rise to population in katchi abadis (slums). The study shows that according to Sindh Katchi Abadi Authority, more than 50 per cent of Karachiites live in katchi abadis, while unofficial estimates show there are 702 of them. «This rising population in slums will further give rise to unemployment and subsequently crime. The government must take this problem seriously and devise policies for population planning. This should be our top priority,» insists Bilquis Edhi.

Dr Ahmed suggests the Pakistani government should replicate the Bangladeshi model and engage religious scholars to control the country’s population. «The Bangladeshi government reduced their population growth rate from seven per cent to 2.9 per cent largely by seeking the help of local imams at mosques to educate their people and clear misconceptions about religion and use of contraception. Why can’t we use our imams for something constructive as well?» he asks.

The answer lies only with the government.